Objective: to describe indications and results of supraglottoplasty for severe laryngomalacia in children with or without neurological impairment. Methods: eight children with severe laryngomalacia submitted to endoscopic supraglottoplasty were retrospectively studied. Four had neurological impairment (male, mean age 6 years), and 4 did not present neurological problems (3 female, mean age 11.5 months). Surgery indications were respiratory distress, feeding difficulties, failure to thrive, and low oxygen saturation. Polysomnographic evaluation was carried out on the last 2 children, showing abnormal oxygen saturation, obstructive apnea, and hypoventilation. All children received preoperative antibiotics and corticosteroids. Results: all children without neurological impairment had significant relief of symptoms. Children with neurological impairment had different outcome: one needed tracheotomy immediately after surgery due to edema and supraglottic granulation tissue. The other three children presented initial relief of symptoms, but subsequent follow-up showed progressive airway obstruction: one needed another endoscopic surgery 6 months later; other needed tracheotomy 7 months later. The children who were not submitted to tracheostomy presented persistent severe airway obstruction. No endoscopic surgery complication was observed. Conclusions: 1) Endoscopic supraglottoplasty is well tolerated and does not present complications when used in children; 2) Endoscopic supraglottoplasty was efficient in the treatment of children with severe laryngomalacia and in without neurological impairment; however, supraglottoplasty did not resolve airway obstruction in children with neurological impairment.

ResumoObjetivos: descrever as indicações e resultados da supraglotoplastia endoscópica em crianças com e sem lesão neurológica que apresentavam laringomalacia grave.Métodos: estudo retrospectivo de 8 crianças com laringomalacia grave submetidas a supraglotoplastia endoscópica com material de microcirurgia. Quatro crianças tinham paralisia cerebral (todas masculinas, idade média 6 anos) e 4 eram crianças sem doença neurológica (3 femininas, idade média de 11,5 meses). As indicações da cirurgia foram dificuldade respiratória em repouso e/ou esforço, dificuldade de deglutição, deficiência de crescimento e baixa saturação transcutânea de oxigênio. Estudo polissonográfico realizado nas últimas duas crianças mostrou dessaturação na oximetria, apnéia e hipoventilação durante o sono. As crianças receberam corticóide e antibiótico no pré-operatório.Resultados: todas as crianças sem doença neurológica apresentaram melhora significativa do estridor e da obstrução ventilatória. Das crianças com paralisia cerebral, uma necessitou traqueostomia logo após a cirurgia por edema e tecido de granulação supraglótico. As outras três apresentaram melhora clínica inicial, mas pioraram progressivamente, apesar da realização de outros procedimentos: uma necessitou nova supraglotoplastia após 6 meses; outra necessitou traqueostomia após 7 meses. Aquelas sem traqueostomia persistem com obstrução ventilatória grave. Não foi observada complicação do procedimento cirúrgico.Conclusões: 1) a supraglotoplastia é bem tolerada e sem complicações na criança; 2) a supraglotoplastia, neste estudo, mostrouse eficaz no tratamento da laringomalacia grave em crianças sem paralisia cerebral; entretanto, a supraglotoplastia não melhorou a obstrução ventilatória de crianças com paralisia cerebral e laringomalacia grave. AbstractObjective: to describe indications and results of supraglottoplasty for severe laryngomalacia in children with or without neurological impairment.Methods: eight children with severe laryngomalacia submitted to endoscopic supraglottoplasty were retrospectively studied. Four had neurological impairment (male, mean age 6 years), and 4 did not present neurological problems (3 female, mean age 11.5 months). Surgery indications were respiratory distress, feeding difficulties, failure to thrive, and low oxygen saturation. Polysomnographic evaluation was carried out on the last 2 children, showing abnormal oxygen saturation, obstructive apnea, and hypoventilation. All children received preoperative antibiotics and corticosteroids.Results: all children without neurological impairment had significant relief of symptoms. Children with neurological impairment had different outcome: one needed tracheotomy immediately after surgery due to edema and supraglottic granulation tissue. The other three children presented initial relief of symptoms, but subsequent follow-up showed progressive airway obstruction: one needed another endoscopic surgery 6 months later; other needed tracheotomy 7 months later. The children who were not submitted to tracheos...